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Permit
if CITY OF T I GA R D ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00377 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 9/28/2007 PARCEL: 2S 104BD - 00500 SITE ADDRESS: 12615 SW 136TH CT ZONING: R - SUBDIVISION: HUSKE PARTITION LOT: 003 JURISDICTION: TIG PROJECT: HUSKE Project Description: Installation of all encompassing low voltage. A. RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING: BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT: GARAGE OPENER: CLOCK: MEDICAL: HVAC: DATA/TELE COMM: NURSE CALLS: VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE: OTHER: ALL ENCOMP : X HVAC: PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: • TOTAL # OF SYSTEMS: Owner: Contractor: PATRICK HUSKE TECHNOCOM INC. 23352 SW MURDOCK RD 7929 SW BURNS WAY # F SHERWOOD, OR 97140 WILSONVILLE, OR 97070 Phone: 503- 625 -5180 Contact #: PRI 503 - 682 -4195 FAX 503 - 682 -2781 Reg #: ELE 34- 269CLE FEES LIC 73872 Description Date Amount SUP 2281 LEA [ELPRMT] ELR Permit 9/28/2007 $75.00 [TAX] 8% State Surcha 9/28/2007 $6.00 REQUIRED ITEMS AND REPORTS Total $81.00. This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requir: ou to f•llow rules adoptr by the Oregon Utility Noti ion enter. T• •se rules are set forth in OAR 952 - 001 -0010 through OAR 95 ' -001 010'. You may obtal copies of these rules or irect questions . OUNC :t 503.246.6699 or 1.800.332.2344. Issue By: k _ /, i. s Permittee Signature: j' ' I ►.te OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lea-e, or rent. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: DATE: LICENSE NO: Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Electrical Permit Application / -FOR OFFICE USE ONLY cot <f ''' Received C Q ^ City of Tigard Date/By: t Q Permit No.: C i _0 7 7.--en - 377 1114 y: a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other Permit T I GA RD Inspection Line: 503.639.4175 Date Ready /By: Jur ® See Page 2 for Internet: www.tigard or.gov Notified/Method: - 7 I Supplemental Information TYI,E OF WORK PLAN REVIEW ❑ New construction ddition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: El Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately denved system. ❑ Addition of new motor load of ❑ "A ", "E ",' l - ", "1 - ", �// ) I OOHP or more. occupancy. Job no.: Job site address: Z1s /5 w / 3 6 9 A ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State /ZIP: 7` t 01 7/Y() ❑ Health -care facilities. ❑ Supply voltage for more than (C/ J ❑ Hazardous locations. 600 volts nominal. Suite /bldg. /apt. no.: r Project name: ❑ Service or feeder 600 amps or more. /�'` `7Z � / c FEE SCHEDULE / Cross street/directions to job site: ' ® .L � i1 11 � / iv ,i - Description Qty. I Fee. I Total C V� ✓(J rWWVw New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4 Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1 Limited energy, residential 1 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) � Vq Limited energy, multi- family 75.00 2 L O tA) D I - q' l t U residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation ;-2„1—" E-Oez AI n vvv il 200 amps or less 80.30 2 PROPERTY OWNER . ❑ TENANT 201 amps to 400 amps 106.85 2 (� 401 amps to 600 amps 160.60 2 Name: p,P ° F 601 amps to 1,000 amps 240.60 2 Address:. 2 : 3qZ S(� �k Pal/ Over 1,000 amps or volts 454.65 2 . City/State /ZIP: 51 r(4 „ ,, 1 (77 / (r �. Temporary services or feeders installation, alteration, and/or ✓� ^u Gr relocation Phone: ( ) ,c 57 go Fax: (5'63) .. 1e — L)^z_ 200 amps or less 66.85 1 Owner ins This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 s intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 Branch circuits — new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with • APPLICANT ❑ CONTACT PERSON above service or feeder fee, each branch circuit 6.65 2 Business name: milk / B. Fee for branch circuits without service or feeder fee, Contact name: �lL 5 first branch circuit 46.85 2 Address: Po ' re/ Each add'I branch circuit 6.65 2 S _ ©6d Ca qF,W Miscellaneous (service or feeder not included) City/State /ZIP: / 1 � 1C _ j __ Each sc manufactured o factured or modular dwelling, service and /or feeder 90.90 2 Phone: ( ib 3) 6z 7 Fax: : ( 03) 6z4 /7. Z Reconnect only 66.85 2 E -mail: / Pump or irrigation circle 53.40 2 CONTRACTOR Sign or outline lighting 53.40 2 • Signal circuit(s) or limited- Business name: { ckia /7 - 7 energy panel, alteration, or Address: :5 e .5 2 419-e extension. Describe: Page 2 2 City/State /ZIP: PO-r'..1_{ 0Q q*-1-27 `, Each additional inspection over allowable in any of the above l Per inspection 62.50 Phone: (c.03 J t Fax: ( ) Investigation per hour (I hr min) 62.50 CCB C 2 d 7 _ Lic.: 3 Electrical Lic..3 f Z6r_ Suprv. Lie.: Industrial plant per hour 73.75 J t/ / C ! - ELECTRICAL PERMIT FEES' Suprv. Electrician signatu -, re.uirer Subtotal: 6?5a0 Plan review (25% of permit fee): Print name: Date: 7,----20a),.., 07 State surcharge (8% of permit fee): 0' i Authorized signatures /J; .. 4I TOTAL PERMIT FEE: 7 I .i D This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. * Number of inspections allowed per petmit. C\ Building \Permits\ELC - PermitApp.doc 05/23/06 440 -46t 5T(I I /05 /COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information s T LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for Al residential systems combined $75.00 Check Type of Work Involved: Q ' A udio and Stereo Systems* n B • urglar Alarm ❑ G arage Door Opener* n Heating, Ventilation and Air Conditioning System* El Vacuum Systems* • Other: • COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918 260 - 260) Check Type of Work Involved: n Audio and Stereo Systems ❑ Boiler Controls n Clock Systems n Data Telecommunication Installation n Fire Alarm Installation n HVAC n Instrumentation n Intercom and Paging Systems n Landscape Irrigation Control* n Medical n Nurse Calls 0 Outdoor Landscape Lighting* 0 Protective Signaling n Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I \Building \Permits\ELC- PermitApp doc 03/23/06 CITY OF TIGARD - BUILDING DIVISION PERMIT #: ELR Otl7 00377 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: a'28/2007 Phone: (503) 639 -4171 Ai 4H��{uW Inspection Requests (24 Hrs.): (503) 639 -4175 .,_....191 I I.. INSPECTION WORKSHEET FOR DATE: 10/1/2007 TIME: 7 :00AM PAGE: 12 SITE ADDRESS: 12615 SW 136TH CT CLASS OF WORK: SUBDIVISION: HUSKE PARTITION LOT #: 003 TYPE OF USE: PROJECT NAME: HUSKE • DESCRIPTION: Installation of all encompassing low voltage. OWNER: HUSKE, PATRICK PHONE #: 603-625-5180 CONTRACTOR: TECHNOCOM INC PHONE #: 503..682 -4195 Inspection Request Scheduled For: Date: 10/112007 Pour Time: Code # Inspection Description Confirm # Contact # Message Low vo a 056669 -0 503- 939 -5546 N C orrec ions/ men s nstructions: ,\ N. \sN V \ i1 1 I v V , n PARTIAL APPROVAL ❑ CANCEL n NO ACCESS C.S____PASS__ FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: , v66 1 Date: 4e I n 1 Phone #: (503) 718 - 2 4 Lib